Atch10 SDVOSB-SelfPerformanceCertificationWrksht Revised 22 Aug 2022.pdf

CALCULATION OF SELF-PERFORMED/SUBCONTRACTED WORK

FA2521-22-B-0020

DBEH 22-1621, Remove/Replace

In accordance with FAR 52.219-14, (Limitations on Subcontracting (Sep 2021), by submission of an offer and execution of a contract, the Contractor agrees that in performance of a contract assigned a North American Industry Classification System (NAICS) code for --(3) General construction, it will not pay more than 85 percent of the amount paid by the Government for contract performance, excluding the cost of materials, to subcontractors that are not similarly situated entities. Any work that a similarly situated entity further subcontracts will count towards the prime contractor's 85 percent subcontract amount that cannot be exceeded; or.

Complete Calculation below and submit with your proposal.

Calculation

#1. Total Contract Value (TCV) for Prime Offeror/Contractor (SDVOSB) and similarly situated entities $ _____________

#2. ALL Material Costs associated with this contract - $ _____________

#3. Subtract ALL Material Costs (#2) from TCV (#1) $ _____________ SubTotal 1

#4. Total Value of all NON-SDVOSB (excluding Materials Costs) $ _____________

#5. Subtract Total Value of all NON-SDVOSB costs (#4) from SubTotal 1 (#3) $ _____________ SubTotal 2

#6. (SubTotal 2 (#5) divided by SubTotal 1 (#3)) X 100% ___________% (must be 15% or more)

I certify the above representations are true and correct to the best of my knowledge.

(Signature and Typed Name of Authorized Representative) Date

(Title of Authorized Representative) Name of Company